大黄灌肠辅助早期肠内营养对重症胰腺炎肠屏障功能的疗效分析

目的研究大黄灌肠辅助早期肠内营养对重症急性胰腺炎（SAP）患者肠屏障功能的临床治疗效果。方法2013年5月至2015年1月SAP患者46例，随机分为单独治疗组和联合治疗组，各23例。单独治疗组采用早期肠内营养治疗，联合治疗组在单独治疗组的基础上采用大黄水煎液保留灌肠治疗。收集患者入院后第1、5、7天的血清D-乳酸、内毒素及入院第l天和第7天的APACHE-Ⅱ、肠鸣音恢复时间。结果入院第1天两组患者血清内毒素、D-乳酸比较差异无统计学意义（P〉0．05）；入院第5天、第74两组内毒素、D-乳酸相比第1天下降，差异均有统计学意义（P〈0．05）；且联合治疗组血清内毒素浓度、D-乳酸均低于单独治疗组，差异有统计学意义（P〈0．05）。入院后第7天联合治疗组APACHE-Ⅱ评分低于单独治疗组，差异有统计学意义（P〈0．05）；联合治疗组肠鸣音恢复时间短于单独治疗组，差异有统计学意义（P〈0．05）。结论大黄灌肠辅助早期肠内营养能更好的保护肠屏障功能，更快恢复肠蠕动，提高患者预后水平。

Objective To study the clinical effect of rhubarb enema assisted early enteral nutrition in the treatment of patients with severe acute pancreatitis （ SAP ） . Methods We collected 46 SAP patients in our hospital from May 2013 to January 2015, and they were divided into separate treatment group and combined treatment group according to randomly number, 23 cases in each group. In sepatate treatment group, 12 males, 11 females, the mean age is 49.6 years old （ 42 - 55 years old ） . In combined treatment group, 10 males, 13 females, the mean age is 50.1 years old （43-57 years old ） . Patients, serum D-lactate, endotoxin after 1 day, 5 days, 7 days admission were collected, and APACHE-Ⅱ after 1 day, 7 days admission and bowel sounds recovery time also were collected. Results No significance difference （ P〉0.05 ） was found in the comparison of the serum endotoxin, D-lactate after lday admission between two groups. After 5 days, 7 days of admission, the index was less than that of 1 day after admission （ P〈0.05 ） ; and serum endotoxin, D-lactate in the combined treatment group were lower than separate treatment group （ P〈0.05 ） . After 7 days admission, APACHE-II value in the combined treatment group was lower than separate treatment group （ P〈0.05 ） . Bowel sounds recovery time in combined treatment group was shorter than separate treatment group （ P〈0.05 ） . Conclusion Rhubarb enema assisted early enteral nutrition can protect intestinal barrier function better, and recover intestinal activity faster, to achieve an improved patient＇ s prognosis.